confusion assessment method (CAM)
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Indications
Procedure
- acute change in mental status & fluctuating course*
- inattention* (see attention assessment)
- disorganized thinking, or
- altered level of consciousness (lethargic, stuporous, or comatose)
* Diagnosis of delirium requires the presence of these features & either disorganized thinking, or altered level of consciousness
* inattention may be tested with digit span, days of the week or months of the year forward & backward (see attention assessment)
Notes
- CAM-S provides a delirium severity measure relevant to clinical outcomes[4]
- scores range from 0-7 (short form), 0-19 (long form)
- adaptation incorporates
- 3D-CAM is a 3-minute structured diagnostic assessment for delirium
- high sensitivity & specificity for diagnosis of delirium in hospitalized patients
- UB-CAM is a version of 3D-CAM that can be completed in ~1 minute
- the CAM itself requires substantial interviewer training
- apparently a CAM-ICU works as well that does not require verbal responses
- the Family Confusion Assessment Method (FAM-CAM) is concise, easy to use, appropriate for routine clinical practice with sensitivity of 0.74 & specificity of 0.91[9]
Additional terms
References
- ↑ Pisani MA, Redlich C, McNicoll L, Ely EW, Inouye SK. Underrecognition of preexisting cognitive impairment by physicians in older ICU patients. Chest. 2003 Dec;124(6):2267-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14665510
- ↑ Jump up to: 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2021.
- ↑ Jump up to: 3.0 3.1 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ Jump up to: 4.0 4.1 4.2 Inouye SK et al The CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts. Ann Intern Med. 2014;160(8):526-533. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24733193 <Internet> http://annals.org/article.aspx?articleid=1860529
EubankKJ and Covinsky KE Delirium Severity in the Hospitalized Patient: Time to Pay Attention. Ann Intern Med. 2014;160(8):574-575 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24733202 <Internet> http://annals.org/article.aspx?articleid=1860540 - ↑ Jump up to: 5.0 5.1 Thomas C, Kreisel SH, Oster P et al Diagnosing delirium in older hospitalized adults with dementia: adapting the confusion assessment method to international classification of diseases, tenth revision, diagnostic criteria. J Am Geriatr Soc. 2012 Aug;60(8):1471-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22881707
- ↑ Inouye SK, van Dyck CH, Alessi CA et al Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990 Dec 15;113(12):941-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2240918
- ↑ Marcantonio ER, Ngo LH, O'Connor M et al. 3D-CAM: derivation and validation of a 3--minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med. 2014;161:554-561 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25329203
- ↑ Jump up to: 8.0 8.1 Kuczmarska A, Ngo LH, Guess J, O'Connor MA et al Detection of Delirium in Hospitalized Older General Medicine Patients: A Comparison of the 3D-CAM and CAM-ICU. J Gen Intern Med. 2015 Oct 6. [Epub ahead of print] PMID: https://www.ncbi.nlm.nih.gov/pubmed/26443577
- ↑ Jump up to: 9.0 9.1 Zhou C, Wang H, Wang L, Zhou Y, Wu Q. Diagnostic accuracy of the Family Confusion Assessment Method for delirium detection: A systematic review and meta-analysis. J Am Geriatr Soc. 2023 Nov 29. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38018490 Review.